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Das fortgeschrittene Urothelkarzinom der Harnblase beim älteren Patienten

Ein Überblick über Inzidenz, Prognose und therapeutische Möglichkeiten

Advanced bladder cancer in elderly patients

Prognostic outcomes and therapeutic strategies

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Zusammenfassung

Einleitung

Das Alter wird zunehmend als größter Risikofaktor für das Auftreten eines Urothelkarzinoms der Blase (UCB) angesehen. Dieser Übersichtsartikel gibt einen Überblick über die Inzidenz, Prognose, operative und medikamentöse Therapie des UCB beim älteren Patienten (>65 Jahre).

Ergebnisse

Ältere Patienten haben eine ca. 11fach erhöhte Inzidenz und 15fach erhöhte Mortalität für ein UCB im Vergleich zu jüngeren Patienten. Trotzdem werden ältere Patienten seltener und verzögert einer operativen oder medikamentösen Therapie zugeführt. Bei adäquater Patientenselektion werden jedoch unabhängig vom Harnableitungstyp vergleichbare operative Ergebnisse und Komplikationen berichtet, so dass die radikale Zystektomie dem älteren Patienten nicht vorenthalten werden sollte. Eine perioperative Chemotherapie ist in Abhängigkeit vom physiologischen Zustand und Komorbiditäten ebenfalls möglich. Die korrekte Patientenselektion sowie frühe, proaktive postoperative Rehabilitation sind jedoch für gute Ergebnisse unerlässlich.

Schlussfolgerung

Bei akkurater Patientenselektion stellen die radikale Zystektomie mit Harnableitung und systemische Chemotherapie sichere und effiziente Therapiemöglichkeiten des fortgeschrittenen UCB beim älteren Patienten dar.

Abstract

Introduction

Age is suggested to be the greatest single risk factor for developing urothelial carcinoma of the bladder (UCB). This review presents an overview of the incidence, prognosis, surgical and medical therapy of UCB in elderly patients (> 65 years).

Results

Elderly patients have an approximate 11-fold increase in the incidence and a 15-fold increase in UCB mortality when compared to younger individuals. However, adequate surgical or medical treatment is less often or delayed offered to elderly patients. In properly selected cases, similar surgical outcomes and complication rates are reported in elderly patients, regardless of the type of urinary diversion. Application of perioperative systemic chemotherapy is dependent on physiologic deterioration and comorbidities. An adequate, restrictive case selection and early proactive postoperative rehabilitation are important factors to achieve good results.

Conclusions

In adequately selected elderly patients, radical cystectomy and urinary diversion as well as systemic chemotherapy are feasible, safe and efficacious treatment options for advanced UCB.

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Rink, M., Chun, F., Chromecki, T. et al. Das fortgeschrittene Urothelkarzinom der Harnblase beim älteren Patienten. Urologe 51, 820–828 (2012). https://doi.org/10.1007/s00120-011-2769-2

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